body metabolism and nutrition

8/14/2019 Body Metabolism and Nutrition

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Metabolism

Prepared by:

John Gil B. Ricafort, RN


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Objectives:

Review of Digestive System

Common Assessment Findings

Common Diagnostic Tests/Procedures

Disturbances


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c. Intestinal Gas

d. Nausea and vomitinge. Change in bowel habits

and stool characteristics

f. Jaundice

g. Pruritus

h. Increased bleeding


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Common Diagnostic Tests

a. Stool Tests

b. Breath Tests

- Hydrogen Breath Test-used to evaluate CHOabsorption and bacterialovergrowth.


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- Urea Breath Test

- detects the presence of H.

Pylori

Note: The person takes a capsule ofcarbon labeled urea and then

provides breath sample 10 to 20minutes after.

*AVOID antibiotics

*AVOID Sucralfate/ Omeprazole

*AVOID Tagamet/ Pepcid/ Zantac


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c. Abdominal Ultrasonography

d. Upper GI Series (BariumSwallow)

- its a fluoroscopic examinationof the upper GI tract to determinestructural problems and gastricemptying time; Client mustswallow barium sulfate or other

contrast medium.


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- sequential films taken as it movesthrough the system.

Nursing Responsibilities: PRETEST

1. Keep NPO after midnight or 6-8 hours

pretest.

2. Explain that the barium will tastechalky.


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Nursing Responsibility: POSTTEST

1. Administer laxatives to enhance

elimination of barium and preventobstruction or impaction.

e. Lower GI Series ( Barium Enema)- Barium is instilled into the colon byenema; client retains the contrast

while x-rays are taken to identifyabnormalities


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1. Keep on NPO for 8 hours pretest

2. Give enemas until clear the morningof test

3. Administer laxative or suppository

4. Explain that cramping may beexperienced during the procedure.


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Nursing Responsibility: POSTTEST

1. Administer laxatives and fluids to

assist in expelling barium.

f. Endoscopic studies

g. Liver Biopsy

- invasive procedure where a needle isinserted into the liver to remove asmall piece of tissue for study.


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1. Ensure the client has signed the

consent form.2. Keep NPO 6-8 hours pretest.

3. Instruct the client to HOLD BREATH

during the procedure.

Nursing Responsibilities: POSTTEST

1. VS taking every hour for 8-12 hours


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2. Place client on his RIGHT SIDE for afew hours with a pillow against his

abdomen to provide pressure on theliver.

3. Observe the punctured site for

hemorrhage.4. Assess for complications of shock and

pneumothorax.


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Disturbances:

1. Gastritis

- inflammation of the gastric orstomach mucosa, is a common GIproblem.

Clinical Manifestation:

abdominal discomfortheadache

nausea and vomiting


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Hiccuping

Anorexia

Heartburn

Sour taste in the mouth

Nausea and vomitingAssessment and Diagnostic Findings:

Endoscopy

Upper GI radiographic StudyHistologic Exam


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Medical Management:

The gastric mucosa is capable of healing

itself for about 1 day after gastritis.Ingestion of acid neutralization

Ingestion of alkaline neutralization

NG IntubationAnalgesic Agents/ Sedative

Antacids

AntibioticsModify Diet, STRESS management


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Nursing Diagnoses:

1. Anxiety related to treatment

2. Altered Nutrition: Less than

Body Requirement related toinadequate intake of nutrients.

3. Acute Pain related to irritated

stomach mucosa


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Nursing Interventions

1. Reducing anxiety

2. Promoting optimal nutrition

3. Promoting fluid balance

4. Relieving pain


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2. Peptic Ulcer Disease (PUD)

- is an excavation that forms in themucosal wall of the stomach, in thepylorus, in the duodenum and in theesophagus.

Types:

a. Lower Esophageal Ulcer

b. Gastric Ulcerc. Duodenal Ulcer


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Clinical Manifestations:

Same with gastritis

Burning sensation in themidepigastrium

Pain relived by eating

Pyrosis

Vomiting

Constipation or diarrheaBleeding


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Assessment and Diagnostic Findings

Endoscopy

Breath Test

Stool Exam

Medical Management

Antibiotics

Antacid

Proton Pump InhibitorsHistamine Receptor Antagonist


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Other Managements:

Stress Reduction and Rest

Smoking Cessation

Dietary Modification

SurgeryBillroth 1(Gastroduodenostomy)

Billroth 2(Gastrojejunostomy)


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Nursing Diagnoses:

1. Acute Pain related to the effect ofgastric acid secretion on damaged

tissue.2. Anxiety related to coping with an

acute disease.

3. Imbalance Nutrition related tochanges in diet.


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1. Relieving pain

2. Reducing anxiety

3. Maintaining optimal nutritional status4. Monitoring & managing complications

Hemorrhage

PerforationPyloric Obstruction


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Assessment and Diagnostic Findings

Complete PE

Laboratory Studies

X-ray

Medical Management

Antibiotics

IV administration

Analgesics (after surgery)Surgery (APPENDECTOMY)


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Complications of Appendicitis:

Perforation most commonSepticemia

Abscess formation

4. Inflammatory Bowel Disease

a. Crohns Disease

b. Ulcerative Colitis


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Crohns Disease

- also known as Regional Enteritis

- a chronic inflammatory bowel diseasethat can affect both the large and smallintestines, but most COMMON in the

megacolon area.- UNKNOWN cause

- onset: 20-30 years and 40-60 years

- both sexes are affected


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- characterized by GRANULOMAS thatmay affect all the bowel wall layers with

resultant thickening, narrowing, andscarring of the intestinal wall.

Clinical Manifestations

Right lower quadrant tendernessAbdominal distention

Decrease skin turgor

Dry mucous membrane

Increase peristalsis


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Nausea and Vomiting

3-4 semisoft stools (ribbon-like)/ day

with mucus and pus

Diagnostic Tests

Decreased Hgb and Hct

Barium enema shows narrowing withareas of strictures


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Medical Management

Diet: High Calorie, High vitamin, High

protein, Low residue, Milk free;Supplementary iron

Pharmacologic Agent

Antimicrobials (Sulfasalazine)

Corticosteroids

Antidiarrheals

Anticholinergics

Surgery: Resection of the diseasedportion and ileostomy


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1. Provide appropriate nutrition while

reducing bowel motility.2. Promote comfort/ rest.

3. Provide care for the client with bowel

surgery


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Ulcerative Colitis

- inflammatory bowel disease

characterized by inflammation andulceration that starts in therectosigmoid area and spreads upward.

The mucosa of the bowel becomesedematous, thickened with eventualscar formation. The colon consequentlyloses its elasticity and absorptive

capabilities.


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- UNKNOWN cause- occurs more often in women

- onset is usually 15-40 years


Severe diarrhea (15-20 liquid stools/day containing mucus, blood andpus)

Severe tenesmus

Weight loss

A i


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Anorexia

Weakness

Crampy discomfortDecreased skin turgor

Dry mucous membrane

Low-grade feverAbdominal tenderness

Diagnostic Tests

Decreased Hgb and HctSigmoidoscopy reveals mucosa thatbleeds easily with ulcer development


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Management

Mild to Moderate from

Diet: Low-roughage diet; NO milkproducts

Pharmacologic Agents

Severe form

Diet: NPO with IVs and electrolytereplacement, NG tube with suction,

Blood transfusion

Surgery


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Factor CROHNS ULCERATIVE

CoursePathology

Early

Late

ManifestationLocation

Bleeding

Fistulas

Diarrhea

Prolonged, variable

Transmural

Deep

Ileum, Right Colon

Usually not

Common

Less severe

Exacerbations

Mucosal

Mucosal

Rectum, Left colon

Common/severe

Rare

Severe


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Nursing Diagnoses

1. Diarrhea related to inflammatoryprocess.

2. Acute Pain related to increasedperistalsis and GI inflammation.

3. Imbalance Nutrition: Less than

body requirements related todietary restrictions, nausea andmalabsorption.


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Nursing Interventions:

1. Maintaining elimination patterns.2. Relieving pain.

3. Maintaining fluid intake.

4. Maintaining optimal nutrition.5. Promoting rest.

6. Reducing anxiety.

7. Monitoring and managing potentialcomplications.


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5. Hemorrhoids

- are dilated portions of veins in the anal

canal usually due to impairment of bloodflow.

- common between 20-50 years old

Types:

a. Internal Hemorrhoids

b. External Hemorrhoids

Manifestations

Pain ProtrusionItching and Bleeding


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Management

Antibiotic

Anti-inflammatory

AnalgesicsStool softeners

SurgeryHemorrhoidectomy


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Clinical Manifestation

Increased abdominal girthRapid weight gain

Shortness of breathStriae

Distended neck veinFluid and electrolyte

imbalances


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Diagnostic Findings

UltrasoundFluid Wave Testing

Medical Management

Dietary ModificationDiuretics

Bed rest

Paracentesis

LeVeen Shunt (Peritoneal-venous Shunt)


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1. Monitor nutritional status/ provide

adequate nutrition with modified diet.Sodium = 200-500mg/day

Fluid = 1000-1500ml/day

Promote high calorie food

2. Monitor/ prevent increasing edema

3. Monitor/ promote skin integrity

4. Promote comfort


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7. Esophageal Varices

- are dilated, tortuous veins usually foundin the submucosa of the loweresophagus, but may develop higher inthe esophagus or extend into the

stomach.- usually caused by portal hypertension

- bleeding varices lead to hemorrhagic

shock, producing decrease cerebral,hepatic and renal perfusion.


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Hematemesis

Melena

General Disorientation

Signs and symptoms of shock

Diagnostic Findings:

Endoscopy

Ultrasonography

CT Scan

Angiography


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Management

Ice normal saline lavage

Administration of Vit. KBlood transfusion

Oxygen administration

Fluid replacementVasopressin vasoconstriction

Nitroglycerin

Balloon Tamponade

- it controls the bleeding by using adouble-balloon (Sengstaken-Blakemore)

C i f P i i h S k


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Caring for Patient with Sengstaken-Blakemore Tube:

1. Facilitate placement of the tube;check and lubricate tip and elevate thehead of the bed

2. Prevent dislodgement of the tube byplacing the patient in semi-fowlersposition; secure the tube properly

3 K SCISSORS h b d id ll


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3. Keep SCISSORS at the bedside at alltimes

4. Monitor respiratory status5. Label each lumen to avoid confusion

6. Observe nares for skin breakdown and

provide oral and nasal care every 1-2hours.


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Endoscopic Sclerotherapy

-injection of sclerosing agent topromote thrombosis and sclerosis

Esophageal Banding Therapy

8. Hepatic Cirrhosis

- a chronic degenerative disease inthe liver in which the lobes arecovered with fibrous tissue, theparenchyma degenerates and thelobules are infiltrated with fat.

t i i i


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- occurs twice in men in women

- onset: 40-60 years ols

Types:

1. Laennec Cirrhosis

2. Postnecrotic Cirrhosis

3. Cardiac Cirrhosis

4. Biliary Cirrhosis


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Intermittent feverSpleenomegaly

Vascular spiders Weight loss

Abdominal pain Edema

Firm, enlarged liver Muscle wasting

Ascites Weakness

Jaundice

Epistaxis

Hypotension

Di ti T t


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Diagnostic Test:

Ultrasound

CT ScanMRI

Laboratory Studies

Increased Liver enzymeMedical Management

Management is based on the

presenting symptoms.COLCHICINE

N i g I t ti


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1. Provide sufficient rest and comfort

2. Promote nutritional intakea. encourage small frequent feeding

b. High calorie, low to moderate

protein, high carbohydrate, low-fatdiet, supplemental vitamin

3. Prevent infection

4. Monitor/ prevent bleeding

5. Administer diuretics


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9. Cholelithiasis

- refers to stones in the gallbladder

Risk Factors:

Obesity

Multiple PregnancyRapid weight loss

Estrogen therapy

Cystic FibrosisDiabetes Mellitus

Cli i l M if i


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Epigastric distress

Abdominal distention

Vague pain in the RUQ of theabdomen

Pain and Biliary Colic

Jaundice

Vitamin Deficiency

Changes in urine and stool color


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Diagnostic Findings:

Ultrasound

Abdominal X-ray

Medical Management

Nutritional and Supportive

Pharmacologic

Ursodeoxycholic AcidChenodeoxycholic Acid


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1. Administer pain medications as

ordered.2. Administer IV fluids as ordered

3. Provide small frequent meals

4. Provide care to relieve pruritus


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10. Pancreatitis

- refers to inflammation of thepancreas due to self-destruction.

- Severe abdominal pain is themajor symptom of pancreatitis

Diagnostic Finding

Based on historyLaboratory studies


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Medical Management

Directed towards relieving thesymptom.

Parenteral Nutrition

Anti-ulcer drugsPain management (DEMEROL)

Respiratory Care

body metabolism and nutrition

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